Peaceful Valley Scout Ranch Adult Leaders Guide
Transcription
Peaceful Valley Scout Ranch Adult Leaders Guide
Peaceful Valley Scout Ranch Adult Leaders Guide MAC W.ES . T. . Table of Contents A Letter From the Ranch Director 3 About Peaceful Valley Scout Ranch 4 Camp Fees 5 Online Registration 8 Preparing for Camp 10 Vehicle Policy 13 Check In 17 Health and Safety 19 Camp Medical Information 22 Emergency Procedures 27 Odds and Ends 33 Page 3 A Word From the Ranch Director Greetings! Congratulations! You have made the decision to join us at Peaceful Valley Scout Ranch for an amazing experience! Whether you are attending a week experiencing the best Scouting has to offer to your Troop at Camp Cris Dobbins, a week mastering your Scout skills as patrols at Camp Cortlandt Dietler, or four days packed with new adventures at Magness Adventure Camp or W.E.S.T., you are in for the time of your life! The Leadership Team at Peaceful Valley works tirelessly throughout the year to upgrade the program at all of the camps for the summer. I am honored to work with the young men and women who believe in the Scouting program and will make a positive impact on your Scouts lives. This guide will prepare and inform you of the policies and procedures during your stay at camp. Please be sure to read through this guide and become familiar with the information it contains. Each camp will have a program guide with information specific to that camp. We appreciate your assistance in being prepared for camp with this information as it will help us ensure you have the best session possible! If you are not sure about anything in this guide, or have any questions, comments, or concerns, please feel free to contact me at anytime. Your feedback in helping us continuously improve is appreciated. Yours in Scouting, Megan Houghton Ranch Director - Peaceful Valley Scout Ranch megan.houghton@scouting.org 720.266.2178 Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 4 About Peaceful Valley Scout P e a c e f u l V a l l e y S c o u t R a n c h is located in central Colorado, 65 miles southeast of Denver, a few miles south of the town of Elbert. The Ranch consists of 3,316 acres of mountain park terrain at 7,000 feet in elevation along the Palmer Divide in the Black Forest. Peaceful Valley also functions as a working ranch throughout the year, with over 1,000 acres devoted to farming and grazing. There are three different Scout camps located on Peaceful Valley, with a description of each located below. C a m p C r i s D o b b i n s - Nestled in the middle of the Black Forest, Camp Cris Dobbins offers sweeping views of Pike’s Peak and the front range of the Rocky Mountains. Scouts will have a hard time choosing between the more than 50 merit badges offered here, and will love spending time on the water slides at the outdoor pool, dusting a clay at the Olympic shotgun range, channeling their inner movie star in our Moviemaking program, or pretending to be Indiana Jones at our STEM lodge archaeology dig site. The convenience of meals from our dining hall and sleeping on raised wooden platforms in canvas wall tents will allow Scouts to focus on the only thing that matters: their next outdoor adventure! C a m p C o r t l a n d t D i e t l e r - As the sun rises and the world slowly starts to come to life, the sound of sizzling bacon on a camp stove can be heard throughout Camp Cortlandt Dietler as cooks from various patrols prepare breakfast. Scouts focus on different goals, and troops who believe summer camp is an opportunity to do more than earn merit badges frequent this little slice of paradise. From challenges designed to strengthen patrol bonds, to camp-wide themed survival outpost nights, Cortlandt Dietler is where boys master outdoor fundamentals, grow leadership abilities, and build character. M a g n e s s A d v e n t u r e C a m p - Looking for an adventure for the whole family? Look no further than Magness Adventure Camp! This Cub Scout family resident camp is your fun-filled, inexpensive, vacation destination. Wonderful tent camping sites and shelters with modern facilities serve as your home away from home during your stay. Meals, are brought directly to you at your shelter, allowing you to spend quality time with your family or pack. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 5 Camp Fees Peaceful Valley requires all Boy Scout troops to follow the 10 youth to every 1 adult ratio with a minimum of 2 adult leaders with the troop at all times. To assist troops, the Denver Area Council covers the cost for the first two adult leaders for every troop. Every additional adult is $200 for the week. Adults that choose to spend a day at camp need to purchase any meals they plan on attending at the time of check in. Please see the visitor section for prices. The youth fees for Summer Camp are dependent on which program your Scout or unit is attending as well as when you want to attend. Please see reference below. For questions on registration, please contact the Colorado Adventure department at 720.266.2111 or camping@denveareacouncil.org. Dobbins and Dietler DAC Units Out of Council Out of CounDAC Units Out of Council *Repeat Units* Out of Council cil Units Using using own *Repeat Units* Using own Units own tents tents tents Dobbins Week 1 June 12 - 18 $350 $350 $375 $375 $400 $400 Dietler Week 1 June 12 -18 $345 $295 $370 $330 $425 $375 Dobbins Week 2 June 19 - 25 $350 $350 $375 $375 $400 $400 Dietler Week 2 June 19 - 25 $295 $245 $330 $280 $380 $330 Dobbins Week 3 June 26 - July 2 $325 $325 $350 $350 $375 $375 Dietler Week 3 July 3 - 9 $295 $245 $330 $280 $380 $330 Dobbins Week 4 July 3 - 9 $325 $325 $350 $350 $375 $375 Dietler Week 4 July 10 - 17 $345 $295 $370 $330 $425 $375 Dobbins Week 5 July 10 - 16 $350 $350 $375 $375 $400 $400 Dietler Week 5 July 17 - 23 $345 $295 $370 $330 $425 $375 Dobbins Week 6 July 17 - 23 $350 $350 $375 $375 $400 $400 Dobbins Week 7 July 24 - 30 $325 $325 $350 $350 $375 $375 Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 6 Out of Council *Repeat Units* - Out of Council units who have attended a Denver Area Council camp 3 or more consecutive summers are eligible for a special rate, which is stated in the previous table. The payment schedule for 2016 is as follows: Campsite Reservation Fee: $250.00 per unit (applied to final payment) First Payment - $50 per Scout (non-refundable) due November 1, 2015 or at the time of reservation after this date Second Payment - $100 per Scout due March 7, 2016 Third Payment - $100 per Scout due April 4, 2016 Final Payment - Balance due May 9, 2016 "No Show" Scouts - If you have “No Show” Scouts at your 2016 Summer Camp check-in, resulting in your overall number to vary significantly from your pre-registration numbers, your unit may be subject to a $100 fee per “No-Show” Scout. Please keep us posted with your current participation numbers. The $250 deposit is non refundable if a unit cancels their reservation. The $50 deposit per Scout is also non-refundable, but it may be transfered to another Scout. Any cancellations before June 1st will receive a refund of all monies paid less the $50 deposit. All cancellations after June 1st will receive no refunds unless there is a doctors note provided or a death in the family. Panning Pete’s Super Troop at Camp Dietler This program provides Scouts the opportunity to attend summer camp if they are unable to go with their own troop or they want to attend an additional week of summer camp. Participants become members of Panning Pete’s Super Troop, a provisional troop that provides Scouts with a similar experience to a traditional troop that attends summer camp. Scouts will participate fully in all programs at Camp Cortlandt Dietler, all the while under a watchful eye of trained adult Scoutmasters who are part of the camp staff. This program is only available at Camp Dietler. Space for this program is limited to 20 Scouts a week. A maximum of 4 Scouts from the same Troop may attend any given week. The fee for Scout participants in Panning Pete’s Super Troop is $345 and the adult fee is $200. A NON-REFUNDABLE deposit of $50.00 per participant is required to reserve your spot. This deposit can be transferred to another week, or to other participants. Full payment is due no later than three weeks prior to the arrival date. For Scouts returning to camp for additional week, payments can be made at the Council Office. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 7 Cub Scout Camping There are multiple choices for Cub Scout camping at Peaceful Valley in the summer! Family Adventure Weekends are open to Scouts of any rank, as well as any family members who wish to attend with them. These weekends are a relaxing time for the whole family to get outdoors and have fun without having to think about the food, activities, or where to sleep. Families arrive Friday at 6 pm to settle into camp and begin having fun through Sunday morning. Cost is $75 for Scouts and siblings over the age of 6, and $50 for any adult over the age of 18. Siblings aged 5 and under may attend at no charge. Magness Adventure Camp is a family friendly setting where Scouts in 1st - 4th grade (as of the following school year) can participate in age appropriate activities. Siblings and parents are welcome to attend and enjoy a few days of Scouting fun with their Scout! Scouts will work on Adventures relevant to their rank as well as spend time at different exciting areas doing fun activities. Participants arrive either Sunday or Wednesday afternoon, stay for three nights and check out either Wednesday or Saturday morning. Cost is $150 for Scouts, $110 for siblings ages 6 or older, and $75 for all adults over the age of 18. Siblings aged 5 and under may attend at no charge. W.E.S.T. is for 5th grade Arrow of Light Scouts where they spend a session experiencing a taste of Boy Scouting while working on current Adventures and having as much fun as possible! Siblings are welcome to join, but may not be allowed to participate in some activities. Participants arrive either Sunday or Wednesday afternoon, stay for three nights and check out either Wednesday or Saturday morning. Cost for this exciting program is $175 for Scouts, $125 for siblings 6 years of age or older, and $100 for adults over the age of 18. Siblings aged 5 and under are welcome to attend at no charge. Dens attending together must follow a minimum of a 5 youth to 1 adult ratio with a minimum of 2 den leaders. Arrow of Light Scouts are welcome to attend with parents even if no other members of the den or pack are attending. For current available sessions, please go to denverboyscouts.org. Any questions? Ask at 720.266.2111 or at camping@denverboyscouts.org Peaceful Valley Leaders Guide - Last Updated 1.22.16 Camperships Page 8 Requests for camperships (scholarships to camp) must be made in writing to the Council Camping Committee (mail to 10455 W 6th Ave, Ste. 100, Denver, CO 80215) detailing why a particular Scout needs financial assistance. A campership application can be requested from the Frederic C. Hamilton Scout Headquarters, or, found on the Council website, www. bsacoloradoadventure.org. All requests should be made prior to April 1, 2015. Camperships cannot be given after attending camp. Only Scouts of the Denver Area Council are eligible for camperships. Online Registration Peaceful Valley uses an online registration system through a partnership with the Doubleknot Company for entering rosters, unit information, and pre-camp sign-up for all merit badge classes and various program activities. Keep the “Logon ID Number” and “Password” from Doubleknot – you will need this information to sign up your Scouts for their merit badges, and make your payments. If your unit does not have internet access, you will be able to handle rosters and class registration by mail. You will receive additional information for online sign up after March 6th. Step-by-step Registration Instructions As you register for merit badges, please keep in mind that even if no payment is due, your merit badge registration, INCLUDING ALL CHANGES AND UPDATES, will not be saved until you complete registration process by clicking the “Done” button. If you feel you have already made the appropriate payments, you still need to select “Pay by Mail” to complete the process and save any changes. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Doubleknot instructions are as follows: Page 9 • Go to www.bsacoloradoadventure.org and click on the Log In tab at the top of the page. Enter your login information. • Under Summary See Upcoming Payments. Under Registration and Reservations, clink on View Details. This will show the unit’s information. • Under Registrations Click on Update/Edit. This is the screen where you can make changes, sign up for merit badges, etc. • Click on Register Individuals. You must register everyone before signing up for merit badges. • Click on Add New Participant, another screen will appear; type in first name, last name and phone number. Under “Type” highlight one of the following: “in-council Scout”, “out of council Scout” or “adult”. Click on Add. Follow procedure for each Scout and adult. After you added all of your Scouts and adults, click continue. This procedure must be completed before Scouts can be signed up for merit badges. • Click on Register by Individual. Next to the Member Name box, click on name of the Scout you wish to register. Next click on Select a Category, and select his badges. After you select the first Scout’s classes, click on the next Scout, and select his classes. Follow this same procedure for each Scout. After you complete the classes for your Scouts, click on Continue. You can print a copy of the troop’s merit badges classes here, but please note classes are not saved until you click on Check Out. • Click on Check Out. • Screen with Payment & Billing Payment will appear, and if you are not making a credit card payment, click the Offline/Mail (mail box) button. Then click on Save. • Next screen – registration, click Done. • The final screen Payment Details Registration, click Done. If all of the procedures are followed, all of your changes will be saved. Remember, each time you make any additional changes; you must complete the entire procedure. If you need any additional information, or have any concerns, please feel free to contact our Camping Registrar, Mary Ann Romero, at 720.266.2111 or maryann.romero@scouting.org. There will be an opportunity at camp to make schedule changes, but we highly recommend you try and finalize your Scout’s schedules before you arrive, as space fills up quickly. Merit Badge Registration Dates Dates for online merit badge registration are staggered and determined by camp attendance weeks at the Boy Scout camp. Merit badge sign-up begins at 8:00 a.m. MST on all dates. Also, please note that some classes have maximum caps, and sign-up for these classes will be on a first come, first serve basis. All merit badge offers and related information will be in the Camp specific program guides available in late winter. Participants at Magness or WEST do not need to register for classes. While there is a chance to sign up for or switch classes when you arrive at camp, some classes may be filled and unavailable. We suggest Scouts pick their classes before registration opens, and then the troop completes registration as soon as possible when it opens. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 10 Week attending camp Date Merit Badge Registration Opens June 12th - 18th April 4 June 19th - 25th April 11 June 26th - July 2nd April 18 July 3rd - 9th April 25 July 10th - 16th May 2 July 17th - 23rd May 9 July 24th - 30th May 16 Preparing for Camp Pre-Camp Leaders Orientation There will be one leader orientation meeting. It will be held on Saturday, April 23th, 2016 at 12:30 p.m. at the Denver Area Council Scout Show. This event will be at the National Western Stock Show complex. It is very important that a unit representative attends this meeting. The camp management will go over any questions leaders have regarding summer camp. If your unit is unable to send a participant, please direct questions to the Ranch Director, Megan Houghton, at megan. houghton@scouting.org or at 720.266.2178. Pre-Camp Swim Checks All campers and leaders who wish to use the pool and boats are required to have completed a swim check within the past year. We can conduct a swim check when you arrive, but to help expedite the check-in process, we strongly recommend that swim checks be done before coming to camp. If you wish to do your own unit swim check, please use the form found later in this handbook. Procedures are explained on the form. Please make three copies of your swim check; two for the aquatics staff, and one for your troop records. When doing the swim check, be sure to have a qualified lifeguard on hand. We do not retain swim test records from previous Council events, so we are unable to look up any records you may have turned in during the past year. This includes if a Scout attends more than one session or week. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Pre-Camp Conditioning Page 11 Peaceful Valley is located at an altitude of 7,000 feet, with steep terrain that you will walk on during your stay at camp. We strongly encourage your troop to participate in a conditioning program prior to arrival at camp. Unfortunately, we frequently have incidents of dehydration and high altitude sickness due to campers not taking the proper precautions. All campers must carry a water bottle with them at all times, and should wear plenty of sunscreen. Adult leaders should ensure that all Scouts drink plenty of water prior to their arrival, and throughout each day. Camp Contact During the summer, the camp attempts to keep the camp phone attended 24 hours, however, there are times when this is impossible. If you don’t reach someone, please leave a message, and it will be returned in a timely manner. Due to the large area of the camp, messages for Scouts and leaders generally are not delivered until the next mealtime. We try to deliver emergency messages immediately. Please limit faxes to emergency information. Peaceful Valley Headquarters Number: 303.648.3023 Fax Number: 303.648.3345 Mail For Campers Please remember mail takes more time in rural areas than in a large city, and letters mailed after Wednesday may not arrive on time. Any mail received after the troop has checked out will be returned to sender. All mail sent to campers should be addressed: Peaceful Valley Scout Ranch Name of camp attending Name of participant, Troop Number PO Box 97 Elbert, Colorado 80106-0097 Cell Phone and Internet Connectivity There is cell service on most parts of camps, no matter who your carrier is. However, coverage can be limited at times, so please do not rely on personal cell phones during your stay. Data service is poor for all providers. Internet access can be found at Peaceful Valley Headquarters, as well the Dobbins Dining Hall and Scoutmaster Lounge. Our goal is provide reliable internet service to all adult leaders, but due to the rural location of Peaceful Valley Scout Ranch, internet service may be restricted at times. Upgrades are in progress, and every effort will be made to keep this service active. When necessary, a list of nearby “Wi-Fi” hotspots in neighboring towns will be provided. You must have your own computer or cell phone. We ask that anyone who connects to the wireless disconnects after they are done to prevent heavy “air traffic”. We appreciate your assistance and understanding while we work on improving the internet capabilities. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Campers with Special Needs Page 12 If a Scout or adult in your unit needs some extra help to enjoy their camp experience, please let us know! We have a few campsites that are easier for those with mobility problems. We can also arrange for access to “indoor plumbing,” or wheelchair-accessible portable toilets, when needed. If your Scout will need some extra attention from our counselors, we can help! If you have such a situation, please contact the Ranch Director, Megan Houghton, at megan.houghton@scouting.org or 720.266.2178, no later than two weeks before your week of camp. A member of camp management will confirm the arrangements with you. Campers with Special Diets Our kitchen staff is willing to accommodate special diets for campers, whether for religious, medical, or philosophical reasons. If a camper has a dietary restriction, make sure it is indicated on their medical form. In addition, please fill out the Special Diet Request Form found on the Council website, www.bsacoloradoadventure.org, in the Camp Library Section, and also alert the Ranch Director, Megan Houghton, at megan.houghton@scouting.org, a minimum of three weeks in advance to request special dietary needs. A member of camp management will confirm the arrangements with you. If this form is not received by then, there is no guarantee that the kitchen will be able to accommodate the dietary needs. On arrival, check with the camp staff, as well as the food service personnel, and they will instruct you on how to get your special meals. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 13 Ve h i c l e P o l i c y During check-in or checkout, one vehicle per unit is allowed to drive on the service roads to the campsite to drop a trailer or any oversized gear. All vehicles are to be returned to the parking lot. Absolutely no non-camp vehicles are allowed to drive into the campsites or off the main roads at any time. If a Scout or adult leader has special mobility needs, a permit can be obtained from the camp medic to drive the individual around camp. You must have a state issued handicap placard or a doctor’s note in order to receive a permit, NO EXCEPTIONS! The driving rules are below, and any violation of these may result in your permit being revoked and fines towards the unit. • • • • • Vehicles must stay on roadways and MAY NOT be driven directly into the campsite. Each occupant of a vehicle should have a proper seat and use a seat belt. Drivers of vehicles must be at least 18 years of age, with a current driver’s license. The maximum speed limit for vehicles on camp is 15 mph. Scouts and leaders are prohibited from riding in the back of pickup trucks or trailers. No vehicles (excluding permitted and camp vehicles) are allowed on the service road outside of check-in and checkout times. This policy also pertains to adults rotating throughout the week. Please be aware that adults will not be able to drive up to their campsite if they are rotating during the week. Anyone checking in late or checking out early must hike their gear between their car and campsite, so please pack accordingly. Campers and motor homes are permitted to stay at camp only in select areas at Peaceful Valley. The main area is at Winchester Flats at Camp Dobbins. In select cases, a camper may be allowed in the lower Dietler lot or one of the Magness shelter lots. However, management reserves the right to deny use of these lots at any point. There are no hookups or dumping stations. We strongly encourage only participants and visitors with extreme needs to utilize this option. Please contact the Ranch Director, Megan Houghton, at 720.266.2178 or megan. houghton@scouting.org before you arrive at camp. Scouts and adults are prohibited from riding in the bed of pickup trucks or on/in trailers. Each occupant of a vehicle should have a proper seat and use a seatbelt. Roads are some of our main trails at camp, and increased traffic adds unnecessary danger to our campers. Excessive use also erodes our roads more quickly. Please help us keep camp safe and beautiful and abide by this policy. Failure to adhere to this policy may result in fines to your troop, with extreme cases resulting in persons possibly being asked to leave. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Packing for Camp Suggested Personal Packing List Page 14 This list is only what we suggest you pack for camp. Which program you and your Scouts are participating in, or personal preference, may require you to pack differently. When packing, think of what you need everyday, and always remember: Be Prepared. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Sleeping Bag Small mattress, cot or pad (mattresses are not provided) Small pillow (optional) Sleep clothing Good walking shoes or hiking boots (please break in before summer camp) Sneakers ( for backup and games) 3-8 pair socks - Preferably wool, easier to dry and keep feet warm when wet. 3-8 changes of underwear 2 pair of shorts - nylon works very well 2-3 T-shirts 1 hat (broad-brim is best) Scout Uniform Belt Swimsuit Long sleeve shirt(s) Long pants Fleece or sweater - Avoid cotton sweatshirts, as they are useless when wet. Outer jacket Rain gear - Needs to cover the whole body. Poncho alone is inadequate. Rain jacket/pants are best. Long underwear - optional for those who get cold easily Stocking cap or beanie - optional Daypack - big enough to carry rain gear, water bottle, class materials Tarp (required for any outpost programs) Water bottle - 1 quart Toilet kit - toothbrush, toothpaste, comb, shampoo, soap, washcloth, lip balm Sunscreen Personal first aid kit - see Handbook Towel(s) Flashlight and extra batteries Alarm Clock and/or wristwatch Notebook and pencils/pens Merit badge books, Scout Handbook Work done at home for merit badges, and/or things needed for Merit Badges Medical Form (completely filled out and signed before camp) Medications in original container Eyeglasses and/or sunglasses Small camera-optional Swim goggles-optional Pocketknife - small - optional, must have whittlin or totin chip. Compass - optional Whistle- optional by troop Spending money, money for class/fees, in a wallet with your name Peaceful Valley Leaders Guide - Last Updated 1.22.16 W h a t N o t To P a c k Page 15 We want every participant who comes to Peaceful Valley to Be Prepared, but there are plenty of items that you should not bring to camp. There are also many items that are prohibited at camp, doing so will result in confiscation or even the participant being asked to leave ranch. We suggest you do not bring the following items: • • • • • Gaming consoles of any kind Laptops or Tablets Excessive amounts of money Expensive electronics Irreplaceable items (books, jewelry, grandfather's pocket knife, etc.) While we do not prohibit you from bringing these items to camp, we take no responsibility if any of these items are lost or broken. Please refrain from bringing any items to camp that may fall into these categories. Cell phone use by Scouts is not allowed in program areas. Troops are encouraged to set their own guidelines for campsite and travel use of electronics. If the troop allows Scouts to bring their cellphones, they must remain put away during classes and program. We do suggest keeping them either locked in the troop trailer or in the Scout's possession. Best practice is to keep it in a ziplock bag or other waterproof container. The following items are NOT allowed at camp. Any person who brings them will have the items confiscated, may be asked to leave, or even have the Elbert Sheriff called. Do not bring any of the following: • • • • • • • • Guns or ammunition of any kind Knifes larger than 3.5" Any other form of weaponry Fireworks or explosives Alcohol Drugs or drug paraphernalia Clothing or items with inappropriate language or graphics Any items that go against the BSA policy, or do not follow the Scout Oath and Law Peaceful Valley Leaders Guide - Last Updated 1.22.16 Suggested Uniforms at Camp Page 16 The official BSA field uniform is always appropriate dress at Peaceful Valley. Every camper is expected to wear the field uniform (often referred to as the “Class A” uniform) at evening flags, dinner or while performing a flag ceremony. Scouts at Dobbins are encouraged to wear it while attending chapel as well. The activity uniform (often called the “Class B” uniform), substituting a Scout T-shirt for the uniform shirt, is encouraged at all other times. Campers should wear sturdy walking or hiking shoes with socks. Lighter shoes may be worn in the campsite. Sandals or shoes without toes are unsafe and not permitted. Inappropriate clothing includes sleeveless undershirts or clothing with foul or suggestive language or graphics. Demonstrate your unit’s Scouting Spirit by being the best-uniformed unit in camp! Campsite and Provided Equipment While every effort will be made to place your troop in their desired campsite, sometimes this is not always possible, and the Camp Director reserves the right to shift troops around as needed to accommodate campsite capacities. At Dobbins and Dietler, your troop might also share a campsite with another troop, depending on each troop’s total number of participants. Each campsite is equipped with a pit latrine with hot showers, and will be stocked with a broom, hose, toilet brush, and other cleaning supplies. There will also be a hand washing station, roll of paper towels, and a soap dispenser in each latrine. We encourage all troops to use their own latrines when it comes to showering, and to have their Scouts and adult leaders ask for permission from other troops if they need to use another campsite’s latrine. Adult leaders may also shower in Gilwell Hall, and Scouts can wear their swimsuits and use the showers on the deck of the pool. There is a flagpole in some campsites, and troops are highly encouraged to bring their troop and patrol flags to hang on it. Units are also encouraged to pioneer a flagpole. At Camp Dobbins and Magness you will be provided with one tent and platform for every two Scouts/adult leaders, as well as at least one dining fly and one picnic table per troop. Cots and mattresses are not provided, and Scouts and adult leaders are encouraged to bring their own. Please note that adult leaders do not get their own tents, and are encouraged to bring their own tents if possible. These can be pitched in specific areas at the troop’s campsite, and your Campsite or Patrol Host can point these areas out upon check-in. At Camp Dietler, troops will only be provided tents if they are renting them. Please note that if your troop registered as bringing your own tents, there will not be any for you in your campsite. Rental tents are 4 person Coleman Sundomes. Cots and mattresses are not provided. There will be patrol boxes, wash buckets, a picnic table, and a dining fly provided for each patrol. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Check In Page 17 Check in is at 1 pm on the first day of your session. For Boy Scouts attending Cris Dobbins or Dietler, this means check in begins at 1 pm on Sunday. For Cub Scouts attending Magness or WEST, check in is either on Sunday or Wednesday, depending on your session. Each camp has a different check in location. Please make sure you read the Program Guide for whichever camp you are attending, as that will give you the best and most specific information. If you need a different check in time for any reason, please contact the Ranch Director, Megan Houghton, at 720.266.2178 or at megan.houghton@scouting.org as soon as possible. For check in you will need a few things. Please make sure you have these: • • • • • • Final payment if unit has not paid in full Troop roster of ALL Scouts in attendance Roster of all adults that will be attending camp and what times List of any “No Show” Scouts (and replacements if necessary) Confirmation of Registered Classes (for Boy Scouts) Med forms for EVERYONE that is staying - All participants must have parts A and B, including parents. Anyone staying over 72 hours need to have part C signed by a physician. Every participant will turn in their own med form to the medic, so make sure the Scouts have theirs. • Colorado Addendum for all participants under the age of 18 • PADI Forms for anyone taking the Friday SCUBA course at Dobbins or Dietler • Release forms for anyone going on the Whitewater trip for Dobbins or Dietler Each program has a different check in process, but are all very similar. Adults will check in with the Camp Director or designated staffer. Scouts will have a quick orientation, complete their med checks, and then settle into their campsite. Campers will be directed to their assigned campsite. While every effort will be made to place your troop in their desired campsite, sometimes this is not always possible, and the Camp Director reserves the right to shift troops around as needed. Your troop might also share a campsite with another troop. Per our vehicle policy, only one vehicle per unit will be allowed to drive to the campsite at Dobbins or Dietler (including WEST). All participants at Magness will be directed to the parking lot next to their shelter, which is easy walking distance to the campsite. All vehicles must return and remain in the designated camp parking lots. Along the way, each participant will meet individually with the medic for a brief history, and anyone under 18 years old will be required to turn in all medications, including over-thecounter medications. The medic will review medications like epi-pens or inhalers, and then return them to the Scout, but all other medications will be held on to and administered by the camp medic. All non-emergent medicine, whether prescribed or over the counter, must be held and administered by a camp medic or other trained personal for participants under the age of 18. The only exceptions to this policy are in cases of a parent or legal guardian administering the medicine to their own child, or, a registered physician, physician’s assistant, or nurse practitioner agreeing to take responsibility in administering, and securely storing the medication. Please do not arrive before 1:00 p.m.; there is plenty of time to check in and get settled before dinner. If you do arrive early, please do not travel around camp. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 18 Adult Leader Roster (Dobbins and Dietler Only) The Camp Scoutmaster must list all adults coming to camp for the week on the Unit Adult Registration Form and turn these forms in while checking in at camp. An accurate, daily list must be completed, which identifies when adults will be arriving and departing. The Camp Scoutmaster will be responsible to update the Unit Adult Registration Form throughout the week if changes occur. Also, during the check-in process, the Camp Scoutmaster must certify that he has seen a current Youth Protection Training certificate for all registered adult leaders listed on the Unit Adult Registration Form who will be remaining on the ranch for more than 24 hours. Adult leaders listed on the Unit Adult Registration Form who will be remaining on the ranch for more than 24 hours and do not have proof of current Youth Protection Training certification will be required to take the training online at Headquarters. Please note that any adult leader can complete youth protection training prior to their arrival by going online to www.myscouting.org. Camp Identification At check-in, you will be given a wristband or another form of identification for each youth and adult who arrives on Sunday. Adults who arrive later in the week must check in at the office, and will receive a form of identification at that time. For your own safety, all participants must wear the appropriate wristband identification while on camp! Peaceful Valley Leaders Guide - Last Updated 1.22.16 Health and Safety Page 19 Yo u t h P r o t e c t i o n Tr a i n i n g f o r A d u l t s All registered leaders listed on the Unit Adult Registration form and who will be remaining at camp for more than 24 hours must have a current Youth Protection Training certificate. Certification is valid for two years, and leaders who have not been through the training will be required to take the training when they arrive at camp. This requirement is to be verified by the Camp Scoutmaster before the troop arrives at camp. Yo u t h P r o t e c t i o n G u i d e l i n e s a t C a m p • Sleeping Arrangements: Adult leaders and Scouts must sleep in separate tents, however, an adult leader may sleep with his/her son. All Scouts must have at least one tent-mate. • Showers and Locker Rooms: Adults over the age of 18 have the option of using the facilities in Gilwell, which is under the dining hall at Camp Cris Dobbins. If unit adult wish to use the latrine facilities in their campsites or at the shelters, they must follow a shower schedule. Units must make this themselves at Camp Dobbins or Camp Dietler. The shower facilities will have a schedule posted at the shelters at Magness Adventure Camp. • Discipline and Treatment: Scouts will not be subjected to physical harm, fear, or intimidation. Scouts will not be roughly handled, struck, or shaken. Separation will be brief and appropriate to the age and circumstance, and in a safe and comfortable place within hearing distance of an adult. Meals may not be denied as punishment. • Language: Verbal abuse, discriminatory or derogatory remarks, and off-color conversation shall not be tolerated. • Leader Conduct: Adult leaders should avoid unnecessary or inappropriate physical contact with Scouts. Two-deep leadership is required at all times. Any one-on-one meetings must be held in a public setting. • Mandatory Child Abuse Reporting: Any adult leader who becomes aware of actual or possible child abuse is required by Colorado law to make a report. Contact the Camp or Ranch Director immediately if you suspect any abuse taking place. They will evaluate the situation, and proceed in accordance with legal requirements and BSA policies. • Discrimination: Peaceful Valley Scout Ranch and the Denver Area Council, B.S.A. is an equal opportunity facility that does not discriminate on the basis of age, sex, color, race, creed, or religion. All participants shall observe this code while on the ranch. Harassment Policy The Denver Area Council and the Boy Scouts of America prohibit language or behavior that belittles or puts down any of its youth or adult members or non-members. This policy includes unwelcome sexual advances, racial slurs, chastisement for religious or other beliefs, or any other actions or comments that are derogatory of people. Any form of hazing, initiations, ridicule, or inappropriate teasing is prohibited. The consequence for any of these actions will result in, but not be limited to: immediate removal from campgrounds and local law enforcement authorities will be contacted. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 20 Yo u t h P r o t e c t i o n P o l i c y I n f o r m a t i o n f o r P a r e n t s The Denver Area Council, Boy Scouts of America, operates summer camping programs that are licensed by the Colorado Department of Human Services. The license indicates that the program has met the required standards for the operation of a child care facility. The current license and most recent inspection are available for review at Headquarters. Every precaution is taken to protect your child’s well-being. Unfortunately, on rare occasion, an incident of physical or sexual abuse may occur. If you believe that your child has been abused, you should seek immediate assistance from your county department of social services. The telephone number to report child abuse in your county is listed below. Arapahoe County Human Services Department 303.636.1750 Adams County Human Services Department 303.412.5212 Denver County Human Services Department 720.944.3666 Douglas County Human Services Department 303.688.4825 Jefferson County Human Services Department 303.271.4357 Clear Creek County Human Services Department 303.569.3251 Gilpin County Human Services Department 303.582.5444 Park County Human Services Department 719.836.2771 Colorado law requires that child care providers report all known or suspected cases of child abuse or neglect. Child care services play an important role in supporting families and strong families are the basis of a thriving community. Your child’s education, physical, emotional, and social development will be nurtured in a well planned and run program. Questions about any program in the Boy Scouts of America, especially with regard to children’s health and safety, equipment, play materials, and staff can be answered by contacting the Council Office at 303.455.5522. Please feel free to observe the program at your convenience as well. For additional information, consult the Colorado Division of Child Care at 1575 Sherman Street, Denver, CO 80203 or by phone at 303.866.5958. Visitor Information Visitors are welcome at any time during the week, but if possible, should make prior arrangements with the unit’s Camp Scoutmaster or Cubmaster. All visitors must check in and out at the specific camp office they are visiting when arriving and leaving camp, and must follow all camp policies. Vehicles must be parked in the parking lot, and not at campsites. There are no facilities or camping areas available for visitors or family members to stay overnight, and program facilities are not available for use by visitors when camp is in session. Meal fees for visitors staying under 24 hours are $6 for breakfast, $7 for lunch and $8 for dinner ($8.50 for Friday Family Night at the Boy Scout camps), and tickets can be obtain upon check-in. If you plan on staying for any meals, with the exception of family night, please email the Ranch Director, Megan Houghton, at megan.houghton@scouting.org at least 24 hours in advance. Be sure to know the troop or pack, and if possible, the patrol, you are planning to eat with. Friday is designated as family night at the Boy Scout camps. Families of Scouts are encourage to visit, eat supper with their Scout, and join us for the Friday night closing campfire. Camp Scoutmasters should be prepared to provide the camp with an approximate count by midweek, so we can ensure enough food is prepared. Dinner starts at 4:30 p.m., but you may arrive at point throughout the day on Friday. All visitors must sign in upon arrival. Meal tickets can be obtained at the office upon check-in and cost $8.50. Children 4 years old and younger eat for free on family night only. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 21 Visiting Adult Requirements Length of Stay Category Registered BSA Member BSA Medical Form Fee Less than 24 Hours Visitor No No Meals More Than 24 Hours Overnight Registered Adult Yes Yes $50/day Youth Protection Trained Not required, always suggested Yes Other Health and Safety Concerns Guns, ammunition, and archery equipment are to be left at home. The camp will provide rifles, shotguns, bows, and ammunition for all shooting sports merit badges and activities. Alcoholic beverages, illegal drugs, and fireworks are not permitted in any Scout camp. Possession, or use of them, on ranch property is cause for immediate removal from camp. In addition, possession or use of federally illegal drugs will be reported to local authorities. No Smoking in any camp buildings on the ranch. If you do smoke, be aware that due to the fire hazard, smoking is strictly limited to your vehicle in the parking lot. Youth may not use tobacco at any time or any location. Open fires are not allowed. Self-contained stoves and lanterns may be used, but not in tents. Charcoal fires for unit cooking may be allowed, depending on state restrictions, and must be in approved containers and have Leadership Team supervision. You must check with Camp Management before starting a charcoal fire. Liquid fuels or starters shall not be used for starting any type of fire, including damp wood, charcoal, and ceremonial fires. Peaceful Valley Scout Ranch follows the recommendations of the Elbert Fire Protection District. The Buddy System should be discussed with Scouts before the troop arrives at camp. It is expected that Scouts practice the buddy system while at camp. Homesickness – Unit leaders are responsible for working with homesick youth. Seasoned Scoutmasters all have their own ways to deal with the problem, but the best “cure” is to be available and patient, keep the Scout busy, and link him up with an understanding older Scout. While we do not encourage campers to call home, remember that it is not a good policy to prevent a Scout from calling his family. In some situations, doing so might be considered a violation of Youth Protection Guidelines. To avoid ill will or worse consequences, please leave the final decision on calling home to the boy. Pets are not allowed. Bicycles - We can provide bikes and helmets for cycling programs, however, there is a $15 rental fee. Youth may not bring bicycles to camp unless enrolled in the Cycling Merit Badge. Youth may not ride bicycles on camp except during merit badge classes or authorized, counselor-led programs. All personal bicycles brought by youth must be kept locked up at the class location or in the campsite when not in use. Adult leaders may bring and use their own bicycles, and may keep them in their campsites. Helmets must be worn properly at all times. Bicycles are allowed on the service roads only. Use a light after dark. Unfortunately at this time, we do not have bikes for rental or use outside of the cycling class. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 22 Camp Medical Information Please read the following section carefully… All participants (youth and adults) attending Peaceful Valley Scout Ranch must complete an Annual BSA Health and Medical Record form. In additional to the medical form, Scouts, or anyone under the age of 18 years old staying on camp for more than 24 hours, must also complete the Colorado Addendum form. This allows Peaceful Valley Scout Ranch to be in compliance with rules from The State of Colorado and Department of Social Services. These forms are available at the Frederic C. Hamilton Scout Headquarters, or on the website, www. bsacoloradoadventure.org, in the “Camp Library” section. Medical examinations for youth and adults are good for one year from the date of the doctor’s examination. Medical forms used last year are archived and not available for use in the following season. All participants must provide a completed medical form for every year they attend camp. All campers and adult leaders staying on camp more than 72 hours must complete Parts A, B, and C of the Annual BSA Health and Medical Record. Anyone staying at camp less than 72 hours but more than 24 hours must provide Parts A and B, which do not require a physician’s signature. This means all participants of Magness or WEST only need parts A and B. All campers, or anyone under the age of 18 years old staying on camp for more than 24 hours, must also complete the Colorado Addendum form. Please make a copy of medical records for your personal travel. In the state of Colorado, camper medical records must be kept on file for 18 years. It is the responsibility of the Scout or troop to make copies of the medical form for future use. All medical forms become the property of the Denver Area Council and will NOT be returned to you at the end of the week. All Scouts and adult leaders are required to participate in a medical recheck upon arrival at camp. Youth participants and adult leaders will individually turn in their completed Annual BSA Health and Medical Record form, and the Colorado Addendum form, if needed, to the camp medical staff, who will review them for any problems. To ensure that forms are available, most troops collect the forms before camp, however, you must distribute them back to the Scouts for the medical recheck. Adult leaders who arrive at a different time than the rest of their unit must turn in their BSA Health and Medical Record form to the medical lodge upon arrival at camp. Shortly after check-in, the Medical Director will give the Camp Scoutmaster a written list of participants with incomplete or missing medical records. The Camp Scoutmaster will be asked to take the necessary steps to correct deficiencies within 24 hours. If by 5:00 p.m. on Monday, a youth participant is still without a COMPLETED Annual BSA Health and Medical Record and/or the Colorado Addendum form, the youth must be picked up Monday night by the parents, or taken home by adult leaders. There is no fee refund. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Medications Page 23 Please read the following section carefully… Under Colorado State Law, medications for youth, including herbal supplements (vitamins) and over-the-counter medications (Advil, Tylenol, Claritin, etc.), must be securely stored and dispensed by the camp medical staff. All medications must be checked in to the camp medical staff, who will then dispense them to campers throughout the week. No adult leader will be allowed to dispense any medication, vitamins, or herbal remedies to any camper, per the Colorado Department of Human Services. The ONLY medications that will be allowed to remain with the camper, by law, are rescue inhalers, epi-pens, or ana-kits for allergic reactions. These items will be inspected at medical recheck, and returned to the Scout. Any adult bringing medication must secure and lock their medication in their campsite. The only exceptions to this policy are in cases of a parent or legal guardian administering the medicine to their own child, or, a registered physician, physician’s assistant, or nurse practitioner agreeing to take responsibility in administering, and securely storing, the medication. All medications must be in original containers, marked with the Scout’s name and troop/pack number on the package with original medication information. Daily pill containers are not permitted under Colorado Law. Please do not cover up the instructions on the medication. Dosages and schedules to be followed in camp must be the same as on the package, and any changes must be stated in writing from the prescribing doctor. Medication in non-original containers will not be accepted. Please send only enough medication for the doses that will be administered for the week, plus a little extra. A letter or prescription from a licensed medical practitioner (MD, DO, PA-C or RNP) must accompany the vitamins or herbal remedies with the name of the camper, the type of vitamins or herbal remedies, the dosage, and the times of dispensing. If these requirements are not met, the vitamins or herbal remedies will not be made available. They will be placed in a locked container in the medical lodge, and returned to the Camp Scoutmaster at the end of the week. Any medications listed on the Scouts medical form MUST be taken while at camp. Scouts will only be excused from taking any prescribed meds with written notice from a physician. The camp medical staff will work with the Camp Scoutmaster to ensure that Scouts are taking their medications. The Camp Scoutmaster will be notified if any Scouts miss their medication times. Scouts who miss three medication times will be sent home. Additionally, it is the responsibility of the Camp Scoutmaster at the departure from camp to collect any medications or herbal supplements for Scouts in their unit. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 24 C PA P ’s Adults or youth needing a CPAP machine while sleeping should have a machine that runs on batteries. There is extremely limited electricity in campsites, and it might not be possible to power CPAP machines in all campsites. There are locations on camp where chargers can be plugged in. Unit Leader First Aid We encourage you to provide first aid for minor cuts, small blisters, etc., using your unit first aid kit. For anything more serious, or any situations requiring medication, please contact the camp health team. Please note that while in camp, you must operate under Colorado Child Care regulations, and are prohibited from dispensing medications. Watch for symptoms for common ailments like dehydration, nosebleed, hypothermia, and diarrhea. We recommend that every unit have one adult leader in camp that has the training equivalent to the First Aid Merit Badge. The Red Cross offers several excellent “Community First Aid” courses. Emergencies and Medical Care Every precaution is taken to insure a healthy and safe camping experience for everyone attending Peaceful Valley Scout Ranch. However, accidents do occur, and in these situations, the ranch medical staff will be responsible for initiating care. Basic treatment within the scope of the camp medical staff standing orders will be provided at no additional cost. The medical staff is available at all times. Unit leaders should contact the medical staff or any Leadership Team member for assistance, EVEN IN EMERGENCIES. The Ranch Director and Medical Director are the individuals that are authorized to call 9-1-1 on our ranch, and should be the only ones to do so in an emergency. Should a non-emergency problem arise, such as an illness that is beyond the scope of our medical staff, we will contact the parents and Camp Scoutmaster. They must then arrange for care, as well as transport, the Scout to a medical facility. We are not able to provide transportation for such situations. The costs of such care must be paid by the parents; insurance claims are filed by the parents. In the event of an injury or illness requiring immediate, specialized, medical attention, the care of your Scout will be turned over to EMS personnel, who at their discretion, may require the use of ground and/or air ambulance services. All expenses associated with medical care are the responsibility of the Scout’s parent(s) or guardian(s). The providers will bill the responsible party. Accident and Sickness Insurance The Denver Area Council has purchased accident and sickness insurance for every Scout and leader. This coverage is excess insurance to any health or accident insurance that a family may already have in place. This coverage is primary only if no other insurance is available. This insurance covers all authorized camp program activities in camp, and also sanctioned camp activities off-property. This insurance does not cover the co-payments for a family’s primary insurance. All claims are handled directly with the insurance company. For questions, contact Valerie Villanueba at the Frederic C. Hamilton Scout Headquarters, 303.455.5522 x2107. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 25 -++ January 2016 Dear Parents of Students in Colorado Child Cares and Preschools (School Year 2016-17), Immunizations are an important part of our children’s and the community’s health. Colorado law requires children attending a licensed child care or preschool to be immunized against certain vaccine-preventable diseases. The purpose of this letter is to remind parents about the need for back-to-school immunizations and to provide immunization information. The chart on page 2 shows which vaccines are required for child care and preschool attendance, along with recommended vaccines which provide more protection against vaccine-preventable disease. There are no changes to the vaccines required from the previous school year. It is helpful to share this letter with your child’s healthcare provider or your local public health agency (LPHA) where your child receives immunizations. Colorado follows the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices schedule. This schedule is approved by the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists. This is the immunization schedule which will best protect your child from vaccine-preventable diseases and is the national standard for health care providers who vaccinate your children. Starting July 1, 2016, parents/guardians seeking non-medical (religious or personal belief) exemptions for prekindergarten children attending child care or preschool must submit non-medical exemption forms at each age when required vaccines are due: 2 months, 4 months, 6 months, 12 months and 18 months of age. Medical exemptions only need to be submitted once and require the signature of your child’s doctor or advanced practice nurse. To submit a non-medical or medical exemption, go to www.colorado.gov/vaccineexemption and follow the instructions. Children with an exemption may be kept out of child care or preschool during a disease outbreak. Parents may have questions or want more information about children’s immunizations and vaccine safety. Resources for parents about the safety and importance of vaccines are available at: www.ImmunizeForGood.com and www.colorado.gov/cdphe/immunization-education. Colorado law requires child cares and preschools to provide school-level immunization and exemption information to the Colorado Department of Public Health and Environment (CDPHE) by December 1, 2016. Immunization and exemption rates for most child cares and preschools will be posted on the CDPHE website as soon as they are verified. Many parents, especially those with children who can’t be vaccinated due to a medical issue, may want to know which schools are best protected against vaccine preventable disease. Please discuss your child’s vaccination needs with your child’s healthcare provider or LPHA and bring your child’s updated immunization records to school each time your child receives an immunization. To find your LPHA or learn about free or low cost vaccines, call the Family Health Line at 1-303-692-2229 or 1-800-688-7777. For questions about school immunization requirements, please contact your school. Sincerely, Jamie D’Amico, RN, MSN, CNS CDPHE Immunization Branch - Schools and Community Coordinator 303-692-2957 | jamie.damico@state.co.us www.coloradoimmunizations.com Peaceful Valley Leaders Guide - Last Updated 1.22.16 1| Page 26 Child Care Immunization Chart 2016-17 Vaccines Required for Child Care, Preschool and K-Entry 1. This chart is a “guide” for childcare providers or parents/guardians to determine which vaccines children are required to have in order to be in compliance with state immunization requirements. Select the appropriate age range for the student from the left hand column. The number of required doses is located in each of the columns and vaccines are listed across the top of the page. Review the student’s immunization record with this chart to make sure they have at least the number of doses required. Colorado Board of Health has accepted the Advisory Committee on Immunization Practices (ACIP) schedule for those immunizations already “required” for attendance. Immunizations that are not required but recommended include: Rotavirus, Hepatitis A and Influenza vaccines. 2. Please follow the ACIP Immunization Schedule for specific guidance at: www.coloradoimmunizations.com, and click on Immunization Schedules. 3. If the student does not have the minimum number of doses, the parent/guardian is to be directly notified (in person, by phone, or by mail) that their child does not have the required minimum number of vaccine doses. Within 14 days of direct notification, the parent/guardian is to obtain the required vaccine(s) or makes a plan to do so providing written documentation of that plan. 4. Colorado law allows for medical exemptions to be signed by a healthcare provider and non-medical exemptions (religious or personal) to be submitted by a parent/guardian. Age of Child By 1 mo. By 3 mos. By 5 mos. By 7 mos. By 16 mos. By 19 mos. By 2 years By K Entry # of required doses DT, DTP, or DTaP Diphtheria, Tetanus and Pertussis 1 2 3 3 4 4 5/4 # of required doses IPV Polio 1 2 2 2 3 3 4/3 # of required doses MMR Measles, Mumps and Rubella 1+ 1 1 2 # of required doses Hib Haemophilus influenzae type b 1 2 3/2 4/3/2/1 4/3/2/1 4/3/2/1 # of required doses Hep B Hepatitis B # of required doses Varicella Chickenpox # of required doses PCV13 Pneumococcal Disease 1✍ 2✍ 2✍ 2✍ 2✍ 3✍ 3✍ 3✍ 1* 1 1 2 1~ 2~ 3/2~ 4/3/2~ 4/3/2~ 4/3/2/1~ - Five doses of DTaP vaccines are required at school entry in Colorado unless the 4th dose was given at 48 months of age or older (i.e., on or after the 4th birthday) in which case only 4 doses are required. There must be at least 4 weeks between dose 1 and dose 2, at least 4 weeks between dose 2 and dose 3, at least 4 months between dose 3 and dose 4, and at least 6 months between dose 4 and dose 5. The final dose must be given no sooner than 4 years of age (dose 4 may be given at 12 months of age provided there is at least 4 months between dose 3 and dose 4). Four doses of Polio vaccine are required at school entry in Colorado. There must be at least 4 weeks between dose 1 and dose 2, at least 4 weeks between dose 2 and dose 3, and at least 6 months between dose 3 and dose 4. The final dose must be given no sooner than 4 years of age. A 4th dose is not required if the 3rd dose was administered at age 4 years or older and at least 6 months after the 2nd dose. + The first dose of MMR, vaccine given more than 4 days before the 1st birthday is not a valid dose and cannot be accepted. ACIP recommends that the 1st dose of MMR be given between 12 -15 months of age. The student is out of compliance if no record of MMR at 16 months of age. The number of Hib doses required depends on the child’s current age and the age when the Hib vaccine was administered. If any dose is given at or over 15 months, the Hib requirement is met. For children who begin the series before 12 months, 3 doses are required, of which at least 1 dose must be administered at, or over, 12 months. If the 1st dose was given at 12 to 14 months, 2 doses are required. If the student’s current age is 5 years or older, no new or additional doses are required. The number of doses and the intervals may vary depending on the type of Hib vaccine. The Hep B vaccine is the only immunization that can be given as a birth dose. The 2 nd dose of Hep B is to be given at least 4 weeks after the 1st dose; 3rd dose to be given at least 16 weeks (4 months) after 1st dose; and last dose to be given at least 8 weeks after 2nd dose and at (24 weeks) almost 6 months of age or older. * If a child has had chickenpox disease and it is documented by a health care provider, that child has met the Varicella requirement. Varicella given more than 4 days before the 1st birthday is not a valid dose and cannot be accepted. ACIP recommends 1st dose between 12 – 15 months. The student is out of compliance if the 1st dose is not given at 16 months of age. ~ The number of doses of PCV13 depends on the student’s current age and the age when the 1st dose was administered. If the 1st dose was administered between 2 to 6 months of age, the student will receive 3 doses (2, 4 & 6 months) at least 4 -8 weeks apart, and booster dose between 12 – 15 months, at least 8 weeks after last dose. If started between 7 to 11 months of age, the student will receive 2 doses, at least 8 weeks apart, and a booster dose between 12 to 15 months of age. If the 1st dose was given between 12 to 23 months of age, 2 doses, at least 8 weeks apart, are required. Any dose given at 24 months through 4 years of age, the PCV vaccine requirement is met. No doses are required once the student turns 5 years of age. Peaceful Valley Leaders Guide - Last Updated 1.22.16 2| Emergency Procedures Page 27 S TA N D A R D R E S P O N S E P R O T O C O L The following are the emergency procedures for situation at camp. At check in, your unit will receive a copy of the procedures. However, please make sure at least one, if not all, of your adult leaders is familiar with these before your arrival. This is adapted from training we give the Peaceful Valley Leadership Team so you are aware of what to expect. SIRENS: • FLAT LONG: Evacuate Area • LONG WAVY: Shelter • SHORT WAVY: Lockdown Condition: A lockout is called when there is a threat or hazard off ranch. This can be on any of the roads around the ranch, in the town of Elbert, or any surrounding area. Whether it is criminal activity nearby, or a dangerous animal on the outside of the property, a lockout uses the physical gates and fences of the ranch to secure all persons and facilities on ranch. Public Address: Only an announcement over the radio is made. “Lockout. Secure the Perimeter. Lockout. Secure the Perimeter.” (The directive is repeated twice.) Actions: “Business as Usual”. All activities should run as normal with the exception of activities at the horse corral and groups that are hiking or biking around the property. Everyone at the horse corral should move to the main camp area so that they are not in view from the road, and in case of Lockdown, they are in a safer location. Groups that are hiking or biking around the ranch should stay close to the main camp area in case of Lockdown. Responsibility: The Ranch Director, Ranger and Ranch Superintendent will be responsible for locking all property gates and ensuring all gates are locked. Reporter: A lockout would be reported to PV Base via phone from the Elbert Sheriff’s Department. They would advise of criminal activity in the area, and suggest that the ranch is secured. It can also be reported to PV Base by anyone witnessing a situation directly off ranch. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 28 Condition: A lockdown is called when there is a dangerous situation or person on ranch. This can range from parental custody disputes that result in threats, an unauthorized person on ranch, or an active shooter. A lockdown uses the existing lockable buildings and heavily wooded areas to protect campers and staff. Public Address: The following radio announcement should be made. “Lockdown! Run! Hide! Fight! Lockdown! Run! Hide! Fight!”. The lockdown siren (short wavy) will then be sounded. Actions: • RUN: If possible, attempt to move away from threat by running into woods with a buddy or small groups. The number one priority of campers and staff should be to run away. They should get far away from the main camp area, but REMAIN ON RANCH. They should hide, and await the all clear siren (Evacuate Area Siren) or wait to be found by first responders, or staff. • HIDE: If running is not possible, find a place to hide. Lock doors, turn off lights, stay silent and out of sight. This should be used if it is not safe or possible to run away. Do whatever is necessary to lockdown and hide in a building. • FIGHT: As a last resort and only if your life is in danger, do what you can to protect yourself. Responsibility: All staff and campers should lockdown following the Run! Hide! Fight! Procedures. The Ranch Director, Ranch Superintendent, and Ranger should be in contact with the Elbert Sheriff’s Department during this time. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 29 Condition: Evacuate Area is called when it is necessary to move all campers and staff to a safe location. This is used for hazards such as a dangerous animal, fire, missing person cannot be found, or to prepare for an evacuation from the ranch. Public Address: The following radio announcement should be made. “Evacuate Area! Report to Assembly Point! Evacuate Area! Report to Assembly Point!”. The Evacuate Area siren should then be sounded. Actions: All campers and staff should report to the closest camp’s Assembly Point. Attendance should be taken using the card system. When proceeding to the Assembly Point, everyone should use trails, not roads. Responsibility: All staff will be at the assembly point and help direct campers in the right direction. Further directions will then be given once everyone has reached the Assembly Point. Camp Assembly Points: • DOBBINS PRIMARY: McKenzie’s Range (flag poles) o SECONDARY: Lake • DIETLER PRIMARY: Commissary o SECONDARY: Parking Lot • MAGNESS PRIMARY: Assigned Shelters o SECONDARY: Headquarters Peaceful Valley Leaders Guide - Last Updated 1.22.16 CARD SYSTEM: Green/Yellow/Red Medical Cards: Page 30 • Upon arrival to Assembly Points for Evacuate Area and Shelter, each unit should group together and form a single file line. o Find the correct unit number written on the white pieces of paper. o This will be held by a staff member until the unit leader arrives. o Take attendance of unit. o Keep the unit number held up until told to take it down. • Once attendance is taken, units should hold up a color status card next to their white unit number card. o GREEN CARD should be held up if all unit members are accounted for, and no medical assistance is needed immediately. o YELLOW CARD should be held up if there are missing unit members. Unit leaders should know exactly who is missing, and be able to report the name once asked by staff. o RED MEDICAL CARD should be held up if a unit member is in need of immediate medical assistance. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 31 Condition: Shelter is called when there is a need for personal protection from hazardous weather. Hazards can include tornados, high winds or heavy rain/hail. Public Address: If the situation requires all campers to report to the shelter, the following radio announcement will be made: “Shelter for __(Hazard)__! Report to camp Shelter! Shelter for __(Hazard)__! Report to camp Shelter!” (The directive is repeated twice). The shelter siren will then be sounded. (Long wavy siren) If the situation does not require shelter in the camp shelter but rather a safe area, only a radio announcement should be made. “Shelter for __(Hazard)__! Report to __(Shelter)¬¬__! Shelter for __(Hazard)__! Report to __(Shelter)¬¬__!” (The directive is repeated twice.) Actions: Staff and campers should act appropriately for the type of hazard and for personal safety. For tornado, staff should help campers report to the camp’s tornado shelter or assembly point. If necessary, staff and campers should take “self-shelter” in a safe location. For other hazards, staff should direct campers to the appropriate safe location announced by the Ranch Director. Responsibility: All campers should report to the appropriate shelter or take self-shelter if it is not possible to report to the appropriate shelter. For a tornado, staff will assist campers in finding units using the card system. Camp Shelter Points: • DOBBINS: Gilwell Hall (Under the Dining Hall) • DIETLER: Commissary then rocks or other area • MAGNESS: Assigned Shelter then rocks, ditches or other area Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 32 Other Emergency Procedures and Information Lost Person For a lost person, check their tent and surrounding campsite. Then check their last known program area or location, and the trading post. If the person cannot be found promptly, immediately notify the camp Leadership Team while continuing to search. Carry Car Keys and a Troop Roster When we assemble after an emergency, we will ask unit leaders to account for all those on your roster. The process will go quicker if you have a roster copy. Adults should always carry a roster while in camp. If it becomes necessary to evacuate camp, we will rely on your drivers for transportation. You may not be able to return to the campsite. Drivers should carry their keys at all times. Contacting Families in an Emergency If your troop should have a need to contact the families of campers, we recommend you set up a “phone tree” suitable to your situation, so that a unit leader can contact one or two people back home, and they can contact families. The unit leaders should carry this information with them at all times. Peaceful Valley Scout Ranch Emergency Drill On opening day of each camp program at the parent/leader meeting, the camp director will review camp emergency procedures as listed above. With respect to emergency drills, the parents/leaders will be informed that the camp will have an emergency drill at the first flag ceremony on Sunday night. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 33 Odds and Ends at the End Thank you for taking the time to become familiar with the information in this guide. Please remember this guide is for general information that applies to the operation of the whole Ranch. Each program will have a specific leader's guide called a program guide. If you have a question about anything in this guide or about Peaceful Valley Scout Ranch, please call Megan Houghton at 720.266.2178 or email her at megan.houghton@scouting.org. The following pages are resources for you. If there is something else we can provide for you, please let Megan know. We can’t wait to see you at Peaceful Valley this summer! H o w t o g e t t o P e a c e f u l Va l l e y From Denver: • I-25 S to Colorado Springs 26.2 miles • Take Exit 184 for US-85 N/Meadows Pkwy toward CO-86 E/Founders Pkwy .3 miles • Turn left onto Meadows Pkwy .2 miles • Continue onto Founders Pkwy .7 miles • Slight right to stay on Founders Pkwy 3.6 miles • Turn left onto CO-8620.6 miles • Turn right onto N Elbert Rd10.2 miles • Continue through the town of Elbert • Turn into Peaceful Valley Scout Ranch (at the second entrance), Dobbins, Dietler, and WEST will be on the left. Magness will be on the right. From Colorado Springs: • Take E Platte Ave east until it turns in CO-24 • Follow CO-24 to Elbert Rd, take a left 14.1 miles • Continue on Elbert Rd 15.2 miles • Turn right on to Peaceful Valley Scout Ranch at the first entrance for Dobbins, Dietler, or WEST. Turn Left for Magness. All visitors need to check-in at the main office of the camp they are visiting. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Swim Classifications Procedures Page 34 The swim classification of individuals participating in a Boy Scouts of America activity is a key element in both Safe Swim Defense and Safety Afloat. The swim classification tests should be renewed annually, preferably at the beginning of each outdoor season. Traditionally, the swim classification test has only been conducted at a long-term summer camp. However, there is no restriction that this is the only place the test is conducted. It may be more useful to conduct the swim classification prior to a unit going to summer camp. All persons participating in BSA aquatics are classified according to swimming ability. The classification tests and test procedures have been developed and structured to demonstrate a skill level consistent with the circumstances in which the individual will be in the water. The Swimmer’s Test demonstrates the minimum level of swimming ability for recreational and instructional activity in a confined body of water with a maximum 12-foot depth and with shallow water footing or a pool or pier edge always within 25 feet of the swimmer. The various components of each test evaluate the several skills essential to the minimum level of swimming ability. Each step of the test is important and should be followed as listed below: SWIMMER’S TEST (Blue Swimmer): Jump feet first into water over the head in depth, level off, and begin swimming. Swim 75 yards in a strong manner using one or more of the following strokes: side stroke, breast stroke, trudgen, or crawl; then swim 25 yards using an easy resting backstroke. The 100 yards must be swum continuously and include at least one sharp turn. After completing the swim, rest by floating. BEGINNER’S TEST (White Swimmer): Jump feet first into water over the head in depth, level off, swim 25 feet on the surface, stop, turn sharply, resume swimming as before, and return to starting place. BEGINNER’S TEST (White Swimmer): Unable to or unwilling to complete either of the other levels. This includes participants who simply do not want to take the test. A D M I N I S T R AT I O N O F S W I M C L A S S I F I C AT I O N T E S T OPTION A (at camp): The swim classification test is completed the first day of camp by the Camp Aquatics personnel. OPTION B (Council conducted/council controlled): The council controls the swim classification process by predetermined dates, locations and approved personnel to serve as aquatics instructors. When the unit goes to a summer camp, each individual will be issued a buddy tag under the direction of the Camp Aquatics Director for use at the camp. OPTION C (At unit level with council-approved aquatics resource people): The swim classification test done at a unit level should be conducted by one of the following council-approved resource people: Aquatics instructor, BSA; Aquatics Supervisor; BSA Lifeguard; certified lifeguard; swimming instructor; or swim coach. When the unit goes to a summer camp, each individual will be issued a buddy tag under direction of the Camp Aquatics Director for use at the camp. SPECIAL NOTE: When swim tests are conducted away from camp or at the point of activity, the Aquatics Director shall at all times reserve the authority to review or retest all participants to ensure that standards have been maintained Peaceful Valley Leaders Guide - Last Updated 1.22.16 Denver Area Council Swim Classification Record Unit _________________________________ Page 35 Date of Test _____________________________ Swim Classification Non-Swimmer Full Name Beginner Swimmer 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Name of Person Conducting Swim Test: Certification: Name _________________________________________________ Signature_____________________________________________ Unit Leader Name _________________________________________________ Signature ___________________________________________ To expedite check in, use this form to record an individual's swim classification status as defined by the Guide to Safe Scouting (#34416D). Any change in status after this date would require a reclassification test by the Camp Aquatics Director. Please note that the Aquatics Director shall, at all times, reserve the authority to review or retest any or all of the individuals to assure that Standards have been maintained. Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 36 Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 37 PARENTAL CONSENT FOR PARTICIPATION IN OLDER SCOUTS MISSION Scout __________________________________________ Unit ___________ Dates in Camp ______________________ Program Description The Mission: program is a special “adventure” program conducted by the staff at Peaceful Valley Scout Ranch (“Ranch”) for Scouts age 14 years of age and older. Possible activities conducted on the Ranch may include kayaking, rock climbing, hiking, shooting, mountain biking or boarding, C.O.P.E. or other low and high ropes courses, and similar “adventure” activities. Participants may also elect to go on an optional excursion away from the Ranch. This trip may include some or all of these activities: trail crew work, backpacking, trekking, climbing, hiking fourteeners, mountain biking or other similar “adventure” activities. The Ranch staff and/or unit leaders, using camp vehicles and/or unit leaders’ personal vehicles, will provide transportation and supervision. Standard BSA safety procedures and camp policies will be followed during all activities, including the off-Ranch trip. There is an additional fee of $65 for participation in Mission: Survival Trek. This includes participation in the off-camp trip. Permission to Participate I understand that participation in the Mission: Survival Trek program offered through the Denver Area Council, B.S.A. involves a certain degree of risk that could result in injury and/or death. In consideration of the benefits to be derived, and after carefully considering the risk involved, and in view of the fact that the Boy Scouts of America is an organization in which membership is voluntary, and having full confidence that precautions will be taken to ensure the safety and well-being of my child, I grant consent for my child’s participation in all Mission: Survival Trek activities, except those noted below. _________________________________________________ Signature of Parent or Authorized Guardian ________________________ Date My child shall not participate in the following Mission: Survival Trek activities (if nothing is noted, we assume there are no restrictions): ______________________________________________________________________________ Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 38 A Part A: Informed Consent, Release Agreement, and Authorization High-adventure base participants: Full name: ________________________________________ Expedition/crew No.: _______________________________ DOB: ________________________________________ Informed Consent, Release Agreement, and Authorization I understand that participation in Scouting activities involves the risk of personal injury, including death, due to the physical, mental, and emotional challenges in the activities offered. Information about those activities may be obtained from the venue, activity coordinators, or your local council. I also understand that participation in these activities is entirely voluntary and requires participants to follow instructions and abide by all applicable rules and the standards of conduct. In case of an emergency involving me or my child, I understand that efforts will be made to contact the individual listed as the emergency contact person by the medical provider and/or adult leader. In the event that this person cannot be reached, permission is hereby given to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for me or my child. Medical providers are authorized to disclose protected health information to the adult in charge, camp medical staff, camp management, and/or any physician or health-care provider involved in providing medical care to the participant. Protected Health Information/ Confidential Health Information (PHI/CHI) under the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. §§160.103, 164.501, etc. seq., as amended from time to time, includes examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities. (If applicable) I have carefully considered the risk involved and hereby give my informed consent for my child to participate in all activities offered in the program. I further authorize the sharing of the information on this form with any BSA volunteers or professionals who need to know of medical conditions that may require special consideration in conducting Scouting activities. or staff position: ___________________________________ With appreciation of the dangers and risks associated with programs and activities, on my own behalf and/or on behalf of my child, I hereby fully and completely release and waive any and all claims for personal injury, death, or loss that may arise against the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with any program or activity. I also hereby assign and grant to the local council and the Boy Scouts of America, as well as their authorized representatives, the right and permission to use and publish the photographs/film/videotapes/electronic representations and/or sound recordings made of me or my child at all Scouting activities, and I hereby release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all liability from such use and publication. I further authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/film/videotapes/electronic representations and/or sound recordings without limitation at the discretion of the BSA, and I specifically waive any right to any compensation I may have for any of the foregoing. ! NOTE: Due to the nature of programs and activities, the Boy Scouts of America and local councils cannot continually monitor compliance of program participants or any limitations imposed upon them by parents or medical providers. However, so that leaders can be as familiar as possible with any limitations, list any restrictions imposed on a child participant in connection with programs or activities below. List participant restrictions, if any: ! None ________________________________________________________ I understand that, if any information I/we have provided is found to be inaccurate, it may limit and/or eliminate the opportunity for participation in any event or activity. If I am participating at Philmont, Philmont Training Center, Northern Tier, Florida Sea Base, or the Summit Bechtel Reserve, I have also read and understand the supplemental risk advisories, including height and weight requirements and restrictions, and understand that the participant will not be allowed to participate in applicable high-adventure programs if those requirements are not met. The participant has permission to engage in all high-adventure activities described, except as specifically noted by me or the health-care provider. If the participant is under the age of 18, a parent or guardian’s signature is required. Participant’s signature: ________________________________________________________________________________________ Date: ______________________________ Parent/guardian signature for youth: _____________________________________________________________________________ Date: ______________________________ (If participant is under the age of 18) Second parent/guardian signature for youth: ______________________________________________________________________ Date: ______________________________ (If required; for example, California) Complete this section for youth participants only: Adults Authorized to Take to and From Events: You must designate at least one adult. Please include a telephone number. Name: ______________________________________________________ Name: ______________________________________________________ Telephone: __________________________________________________ Telephone: __________________________________________________ Adults NOT Authorized to Take Youth To and From Events: Name: ______________________________________________________ Name: ______________________________________________________ Telephone: __________________________________________________ Telephone: __________________________________________________ 680-001 2014 Printing Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 39 B Part B: General Information/Health History High-adventure base participants: Full name: ________________________________________ Expedition/crew No.: _______________________________ DOB: ________________________________________ or staff position: ___________________________________ Age:___________________________ Gender: ________________________ Height (inches): __________________________ Weight (lbs.): ____________________________ Address: ________________________________________________________________________________________________________________________________________ City: __________________________________________ State: __________________________ ZIP code: ______________ Telephone: ______________________________ Unit leader: ________________________________________________________________________________ Mobile phone: _________________________________________ Council Name/No.: __________________________________________________________________________________________________ Unit No.: ____________________ Health/Accident Insurance Company: _________________________________________________ Policy No.: ___________________________________________________ ! Please attach a photocopy of both sides of the insurance card. If you do not have medical insurance, enter “none” above. ! In case of emergency, notify the person below: Name: ___________________________________________________________________________ Relationship: ___________________________________________________ Address: ____________________________________________________________ Home phone: _______________________ Other phone: _________________________ Alternate contact name: ____________________________________________________________ Alternate’s phone: ______________________________________________ Health History Do you currently have or have you ever been treated for any of the following? Yes No Condition Explain Last HbA1c percentage and date: Diabetes Hypertension (high blood pressure) Adult or congenital heart disease/heart attack/chest pain (angina)/heart murmur/coronary artery disease. Any heart surgery or procedure. Explain all “yes” answers. Family history of heart disease or any sudden heartrelated death of a family member before age 50. Stroke/TIA Last attack date: Asthma Lung/respiratory disease COPD Ear/eyes/nose/sinus problems Muscular/skeletal condition/muscle or bone issues Head injury/concussion Altitude sickness Psychiatric/psychological or emotional difficulties Behavioral/neurological disorders Blood disorders/sickle cell disease Fainting spells and dizziness Kidney disease Last seizure date: Seizures Abdominal/stomach/digestive problems Thyroid disease Excessive fatigue Obstructive sleep apnea/sleep disorders CPAP: Yes £ List all surgeries and hospitalizations Last surgery date: No £ List any other medical conditions not covered above 680-001 2014 Printing Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 40 B Part B: General Information/Health History High-adventure base participants: Full name: ________________________________________ Expedition/crew No.: _______________________________ DOB: ________________________________________ or staff position: ___________________________________ Allergies/Medications Are you allergic to or do you have any adverse reaction to any of the following? Yes No Allergies or Reactions Explain Yes No Allergies or Reactions Medication Plants Food Insect bites/stings Explain List all medications currently used, including any over-the-counter medications. CHECK HERE IF NO MEDICATIONS ARE ROUTINELY TAKEN. Medication YES NO Dose IF ADDITIONAL SPACE IS NEEDED, PLEASE INDICATE ON A SEPARATE SHEET AND ATTACH. Frequency Reason Non-prescription medication administration is authorized with these exceptions:_______________________________________________ Administration of the above medications is approved for youth by: _______________________________________________________________________ / _______________________________________________________________________ Parent/guardian signature MD/DO, NP, or PA signature (if your state requires signature) Bring enough medications in sufficient quantities and in the original containers. Make sure that they are NOT expired, including inhalers and EpiPens. You SHOULD NOT STOP taking any maintenance medication unless instructed to do so by your doctor. ! ! Immunization The following immunizations are recommended by the BSA. Tetanus immunization is required and must have been received within the last 10 years. If you had the disease, check the disease column and list the date. If immunized, check yes and provide the year received. Yes No Had Disease Immunization Tetanus Pertussis Diphtheria Measles/mumps/rubella Polio Chicken Pox Hepatitis A Date(s) Please list any additional information about your medical history: _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ DO NOT WRITE IN THIS BOX Review for camp or special activity. Reviewed by:____________________________________________ Hepatitis B Date: ___________________________________________________ Meningitis Further approval required: Influenza Reason: ________________________________________________ Other (i.e., HIB) Approved by: ____________________________________________ Exemption to immunizations (form required) Date: ___________________________________________________ Yes No 680-001 2014 Printing Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 41 C Part C: Pre-Participation Physical This part must be completed by certified and licensed physicians (MD, DO), nurse practitioners, or physician assistants. High-adventure base participants: Full name: ________________________________________ Expedition/crew No.: _______________________________ DOB: ________________________________________ or staff position: ___________________________________ You are being asked to certify that this individual has no contraindication for participation inside a Scouting experience. For individuals who will be attending a high-adventure program, including one of the national high-adventure bases, please refer to the supplemental information on the following pages or the form provided by your patient. ! ! Examiner: Please fill in the following information: Yes No Explain Medical restrictions to participate Yes No Allergies or Reactions Explain Yes No Allergies or Reactions Medication Plants Food Insect bites/stings Explain Height (inches):__________________ Weight (lbs.):__________________ BMI:__________________ Blood Pressure:__________________/__________________ Pulse:__________________ Normal Abnormal Explain Abnormalities Examiner’s Certification I certify that I have reviewed the health history and examined this person and find no contraindications for participation in a Scouting experience. This participant (with noted restrictions): Eyes True Ears/nose/ throat False Explain Meets height/weight requirements. Does not have uncontrolled heart disease, asthma, or hypertension. Lungs Has not had an orthopedic injury, musculoskeletal problems, or orthopedic surgery in the last six months or possesses a letter of clearance from his or her orthopedic surgeon or treating physician. Heart Has no uncontrolled psychiatric disorders. Has had no seizures in the last year. Abdomen Does not have poorly controlled diabetes. If less than 18 years of age and planning to scuba dive, does not have diabetes, asthma, or seizures. Genitalia/hernia For high-adventure participants, I have reviewed with them the important supplemental risk advisory provided. Musculoskeletal Examiner’s Signature: ___________________________________ Date: _______________ Provider printed name: ________________________________________________________ Neurological Address: ______________________________________________________________________ City: _____________________________________ State: ____________ ZIP code: _________ Other Office phone: _________________________________________________ Height/Weight Restrictions If you exceed the maximum weight for height as explained in the following chart and your planned high-adventure activity will take you more than 30 minutes away from an emergency vehicle/accessible roadway, you may not be allowed to participate. Maximum weight for height: Height (inches) Max. Weight Height (inches) Max. Weight Height (inches) Max. Weight Height (inches) 60 166 65 195 70 226 75 Max. Weight 260 61 172 66 201 71 233 76 267 62 178 67 207 72 239 77 274 63 183 68 214 73 246 78 281 64 189 69 220 74 252 79 and over 295 680-001 2014 Printing Peaceful Valley Leaders Guide - Last Updated 1.22.16 Page 42 COLORADO LAW REQUIRES THAT THIS FORM BE COMPLETED FOR EACH SCOUT ATTENDING A COLORADO SCOUT CAMP Name______________________________________________________________________ Date of Birth_____________________________________ Parent/Guardian_____________________________________________________________ Dates of the Camp Session________________________ COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT CERTIFICATE OF IMMUNIZATION Vaccine (Enter the month, day and year each immunization was given.) Hep B Hepatitis B DTaP Diphtheria, Tetanus, Pertussis (pediatric) DT Diphtheria, Tetanus (pediatric) Tdap Tetanus, Diphtheria, Pertussis Td Tetanus, Diphtheria Hib Haemophilus influenzae type b IPV/OPV Polio PCV Pneumococcal Conjugate MMR Measles, Mumps, Rubella Varicella Chickenpox Healthcare Provider Documentation Date________________________ Lab Verification Date_______________________ STATEMENT OF EXEMPTION TO IMMUNIZATION LAW IN THE EVENT OF AN OUTBREAK, EXEMPTED PERSONS MAY BE SUBJECT TO EXCLUSION FROM CAMP AND TO QUARANTINE. MEDICAL EXEMPTION: The physical condition of the above named person is such that immunization would endanger life or health or is medically contraindicated due to other medical conditions. Medical exemption to the following vaccine(s): Signed _______________________________________ Date _________________ Physician (Medico) La exención por razones médicas aplica a la(s) siguiente(s) vacuna(s): HepB DTaP Tdap Hib IPV PCV MMR VAR RELIGIOUS EXEMPTION: Parent or guardian of the above named person or the person himself/herself is an adherent to a religious belief opposed to immunizations. Religious exemption to the following vaccine(s): Signed _______________________________________ Date _________________ Parent, guardian, emancipated Scout/counseling minor Exención por motives religiosos de la(s) siguiente(s) vacuna(s): HepB DTaP Tdap Hib IPV PCV MMR VAR PERSONAL EXEMPTION: Parent or guardian of the above named person or the person himself/herself is an adherent to a personal belief opposed to immunizations. Personal exemption to the following vaccine(s): Signed _______________________________________ Date _________________ Parent, guardian, emancipated Scout/counseling minor Exención por creencias personales de la(s) siguiente(s) vacuna(s): HepB DTaP Tdap Hib IPV PCV MMR VAR PARENT/GUARDIAN AUTHORIZATIONS Parent/Guardian Name__________________________________________ Parent/Guardian Address________________________________________ Parent/Guardian Telephone Day__________________________________ Eve_________________________ Cell________________________ Place of Employment___________________________________________ Address_____________________________________________________ Phone #_____________________________________________________ Parent/Guardian Name__________________________________________ Parent/Guardian Address________________________________________ Parent/Guardian Telephone Day__________________________________ Eve_______________________ Cell__________________________ Place of Employment___________________________________________ Address_____________________________________________________ Phone #_____________________________________________________ Individual authorized to take the Scout from camp if different from the parent or guardian: Name___________________________________ Address___________________________________ City______________ ST____ Zip______________ Phone # Day___________________________ Eve______________________________ Cell_____________________________ I hereby authorize the above named person to participate in all special trips or excursions in which the Scout may be walking or riding away from the campsite. Parent/Guardian/Custodial Adult____________________________________________________________ Date_________________________________ The above named person is restricted from the activities listed below: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Parent/Guardian/Custodial Adult____________________________________________________________ Date_________________________________ Peaceful Valley Leaders Guide - Last Updated 1.22.16